When Alvarenga was 5, he gained about 25 pounds within a year and was diagnosed with high cholesterol.

Alvarenga, a sixth-grader at All Souls Catholic School in South San Francisco, was directed by his pediatrician to enroll in “Make it Happen,” a six-month weight program at Mills Health Center that targets youths — between the ages of 10 and 16 — who are overweight, or on the verge of obesity. At least 26 percent of kids in San Mateo County are overweight. About 10 to 15 percent are obese, said Bonnie Deleuw, a nurse for Make it Happen.

It’s an alarming trend pediatricians, nutritionists and exercise physiologists are battling. As a sign of the problem’s proportion, medical professionals recently launched a debate into whether it’s psychologically demeaning or medically necessary to tell children they’re obese.

Their enemy is a fast-paced life laced with ongoing cuts to physical-education classes in schools, and computers and video games that keep children and families sedentary.

“In society, we’ve set our kids up for failure,” Deleuw said. “We used to hunt and gather everything. Now, we basically sit and do everything by remote control, and more than a quarter of kids are overweight.”

Suneil Koliwad, co-director of the Metabolic Syndrome Program, said it’s not enough for pediatricians to tell their patients to cut down on sweets and to exercise more.

Instead, children at risk for obesity need nutritionists and exercise physiologists to get results. At Make It Happen, they have group leaders who work with patients.

Kids meet twice a week and work out both days. Parents listen to lectures about various health topics and participate in stress-management classes. Also, families carry a pedometer and have to walk a minimum of 10,000 steps a day.

The Alvarenga family had no idea that the pastas and sauces they used to eat were unhealthy, or that juices contained too much sugar.

Their wake-up call came when his pediatrician said Emilio is predisposed to high cholesterol. He now weighs 134 pounds and is about 5 feet tall, said his mother, Maggie Alvarenga.

Since then, they’ve been changing their eating and exercise habits. They bought a Ping-Pong table and a dog named Pebblita (Pebbles), for them to walk every day. They also camp, hike and have dinner together.

“(High cholesterol) is not a disease, it’s just a condition. You have to face it, do what they tell you, and you do it to avoid the consequences of the way you were born,” Maggie Alvarenga said. “We love Emilio, and Emilio loves himself.”

Outside the trained eyes of the Make it Happen program, Koliwad said everyone is moving toward obesity.

“Even the thinnest of us is more obese than the thinnest of us 10 years ago,” he said. “We keep having to redefine the norm.”

Often, Koliwad grapples with telling a patient he or she is overweight or obese.

“It’s an area of controversy,” he said.

Koliwad said the American Academy of Pediatrics does not use the term obese, but the newest obesity task force under the academy does use the term.

“Nothing else conveys the sense of importance of what needs to happen next,” he said. “(But) there is no set stance of what term to use.”

Koliwad’s approach is to build a rapport with his patient and the family, and gauge whether they can handle the news.

Exercise physiologist Bonnie Deleuw chooses not to tell kids in Make it Happen.

“They know they are at risk of developing cardiovascular disease and diabetes,” she said. “They sign a contract to work toward a lifestyle change. These kids are all very motivated and very receptive to changing.”

Emilio Alvarenga said he will continue to do what’s healthy, even after he leaves the program.

“My parents encourage me, and I know they’re going to do it,” he said. “We’re a healthier family. I’d recommend it to another kid.”

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